Reactive Arthritis (Reiter's Syndrome)

What is reactive
arthritis?

Reactive arthritis is a type of arthritis that occurs because of an infection.
Arthritis is when joints become inflamed and painful. Reactive arthritis is not
contagious. It was formerly known as Reiter’s syndrome. It affects men more often than
women. It develops most often between ages 20 and 50.

What causes reactive
arthritis?

Reactive arthritis is not contagious, but it’s caused by some infections that are
contagious. The infections that most often cause the disease are spread through sexual
contact. The bacteria Chlamydia trachomatis. It can cause infections in the bladder,
urethra, penis, or vagina.

Other
infections that can cause reactive arthritis infect the gut. One cause is salmonella.
This infection can come from eating food or handling objects that have the bacteria.

Reactive arthritis may also be linked to genes. People with reactive arthritis often
have the HLA-B27 gene. But many people have this gene without getting reactive
arthritis.

Who is at risk for reactive
arthritis?

Risk
factors for getting reactive arthritis include:

Having
an infection from sexual contact

Having
an illness from contaminated food

Being
male

What are the symptoms of reactive
arthritis?

Reactive arthritis may cause arthritis symptoms, such as joint pain and inflammation.
It can also cause urinary tract symptoms and eye infection (conjunctivitis). Symptoms
can last from 3 to 12 months. In a small number of people, the symptoms may turn into
chronic disease. Symptoms can happen a bit differently in each person, and may
include:

Arthritis symptoms

Joint pain and inflammation that often
affect the knees, feet, and ankles

Inflammation of a tendon that is attached to
bone. This may cause heel pain or shortening and thickening of the
fingers.

Bony growths in the heel (heel spurs) that
can cause chronic pain

Inflammation of the spine (spondylitis)

Inflammation of the lower back joints
(sacroiliitis)

Urinary tract symptoms

Men:

Increased urine

Burning sensation during urination

Discharge from penis

Inflamed prostate gland (prostatitis)

Women:

Inflamed cervix

Inflamed urethra. This causes a burning
sensation during urination.

Inflamed fallopian tubes (salpingitis)

Inflamed vulva and vagina
(vulvovaginitis)

Eye symptoms

Red eyes

Painful and irritated eyes

Blurry vision

Inflamed mucous membrane that covers the
eyeball and eyelid (conjunctivitis)

Inflammation of the inner eye (uveitis)

The symptoms of reactive arthritis can
be like other health conditions. Make sure to see your healthcare provider for a
diagnosis.

How is reactive arthritis
diagnosed?

The
process starts with a health history and a physical exam. Diagnosis can be difficult.
This is because there are no specific tests that can confirm the condition. Some blood
tests may be done to rule out other conditions, such as rheumatoid arthritis and lupus.
Other tests may include:

Erythrocyte
sedimentation rate (ESR or sed rate). This test looks at how quickly red
blood cells fall to the bottom of a test tube. When swelling and inflammation are
present, the blood’s proteins clump together and become heavier than normal. They
fall and settle faster at the bottom of the test tube. The faster the blood cells
fall, the more severe the inflammation.

Tests for
infections. This includes a test for chlamydia. It may also include tests for
other infections that are linked to reactive arthritis.

Joint
aspiration (arthrocentesis). A small sample of the synovial fluid is taken
from a joint. It’s tested to see if crystals, bacteria, or viruses are present.

Urine and
stool samples. These are used to look for bacteria or other signs of
disease.

X-rays. This test uses a small amount of radiation to create images of tissues,
bones, and organs. X-rays are used to look for swelling or damage to the joint. This
can check for signs of spondylitis or sacroiliitis.

Gene
testing. A test may be done to check for HLA-B27.

You may also have testing to rule out other forms of arthritis.

How is reactive arthritis
treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on
how severe the condition is. Treatment may also include:

Antibiotics to treat the infection

Nonsteroidal anti-inflammatory medicines to reduce inflammation

Corticosteroids to reduce inflammation

Immunosuppressive medicines such as methotrexate to control inflammation

Strong
biological immunosuppressants given as a shot

Rest to
ease pain and inflammation

Exercise
to strengthen muscles and improve joint function

What are the complications of
reactive arthritis?

The
main symptoms of reactive arthritis will often go away in a few months. Some people may
have mild arthritis symptoms for up to a year. Others may develop mild, long-term
arthritis. Up to half of people will have a flare-up of reactive arthritis in the
future. In rare cases, the condition may lead to chronic, severe arthritis. This can
lead to joint damage.

When should I call my healthcare
provider?

If
your symptoms get worse or you have new symptoms, let your healthcare provider know.

Key points about reactive
arthritis

Reactive
arthritis is a type of arthritis caused by an infection. It may be caused by
Chlamydia trachomatis, salmonella, or another infection.

The
condition may cause arthritis symptoms, such as joint pain and inflammation. It may
also cause symptoms in the urinary tract and eyes.

Treatment includes antibiotics for the infection, plus medicines to reduce the joint
pain and inflammation.

Most
people recover fully from reactive arthritis.

Next steps

Before you agree to the test or the procedure make sure you know:

The
name of the test or procedure

The
reason you are having the test or procedure

What
results to expect and what they mean

The
risks and benefits of the test or procedure

What
the possible side effects or complications are

When and
where you are to have the test or procedure

Who
will do the test or procedure and what that person’s qualifications are

What
would happen if you did not have the test or procedure

Any
alternative tests or procedures to think about

When and
how will you get the results

Who to
call after the test or procedure if you have questions or problems